Asepsis - what is it? Types, methods, principles and conditions of asepsis
Aseptic and antiseptic - what is it? In modern medicine, this issue remains one of the most common. Knowledge of asepsis and antisepsis remains one of the main sections in the medical specialty.
Asepsis is a set of measures aimed at preventing the penetration of infectious agents into the wound, body tissues, organs and body cavities of the patient. These activities are carried out with the manipulation of the surgical profile and diagnosis.
Asepsis is the destruction of microorganisms by the method of disinfecting and sterilizing processes using physical effects and chemicals.
Types of sources of surgical infections
Two types of surgical infection source are divided: endogenous and exogenous. The first type is located directly in the patient's body, the second - in the environment that surrounds the patient.
In the prevention of endogenous infection, antiseptics are of primary importance, while exogenous ones are assigned to asepsis.
The prevention of endogenous wound infection involves the identification and rehabilitation of infectious foci in a patient who is being prepared for a schedule surgery. Such an operation is subject to transfer in the case when the patient is feverish, he has revealed the presence of purulent skin lesions (asepsis in dermatology), sore throats, caries in the teeth (asepsis in dentistry) or other purulent foci.
When there is contaminated damage in the area adjacent to the surgical field, it is limited to sterile wipes, special films from the surgical incision, is sealed with a medical plaster, and in some cases resorted to suturing, followed by careful treatment of the operating area. And only then perform the very manipulation, strictly observing the rules of asepsis.
Prevention of exogenous infection
Methods of asepsis are used in the fight against exogenous infection. Sources of the latter are patients and bacteriological carriers, especially if they are among medical personnel.
Prevention of drip infections in operating theaters and dressing rooms contribute to arranging them with a special ventilation system (predominantly inflow of air masses over the hood, installing a laminar flow of conditioned air), organizing a special mode of operation in them, carrying out measures that are aimed at the destruction of already existing microorganisms: timely wet cleaning, irradiation of air masses with the help of bactericidal lamps, as well as strict observance by medical staff of the required sanitary standards.
Contact contamination is prevented by sterilizing laundry for the operation, dressing and suture materials, rubber gloves, instruments, special treatment of the surgeon's hands and the field for the operation. Everything that comes into contact with the wound must be free of bacteria, or in other words, sterile. This is the basic principle of asepsis. Sterilization of the material for sutures has a special purpose in the prevention of wound infection. Responsibility for properly performed sterilization is assigned to the operating nurse.
Operating unit mode
Visitors to operating rooms by unauthorized persons are maximally limited, the movement of personnel is reduced. Persons participating in the operational process should be dressed in special medical clothes (sterile gowns, caps, masks, shoe covers). The level of contamination of air masses in the operating room and dressing room is assessed through bacteriological studies conducted with a certain systematic nature.
Preparation for the operation involves a strictly established procedure for preoperative operations. The operating sister should be prepared first for the operation. This process consists of the following sequence: putting on a mask, processing hands, putting on a sterile gown, using the help of junior medical staff, then sterile gloves. This is followed by folding on a sterile table linen, sterile instruments, suture material. Next, the operating surgeon with assistants handles his hands, using the nurse of the operating unit, put on sterile medical clothes and start preparing the area for the operation, fenced with pre-sterile underwear.
When aseptic conditions are created, one of the main measures is sanitation of medical staff of the institution. And only in those cases when it does not bring a positive effect, they resort to labor transfer of carriers outside the surgical departments.
Antiseptic and its types
Antiseptic (and as part of it - aseptic) is a complex of therapeutic and preventive measures that are aimed at the destruction of microorganisms in a wound, another pathological focus or in the whole organism.
There are the following types of asepsis and antiseptics:
1. Preventive antiseptic - aimed at preventing the penetration of microorganisms through the wound surface or into the patient's body (treatment of medical personnel’s hands, treatment of suspected skin lesions with antiseptic preparations, etc.).
2. Therapeutic antiseptic, which is divided into the following methods:
- mechanical (removal of infected and non-viable tissues, primary surgical treatment of wounds, etc.);
- physical (absorbent dressings, hyperosmotic solutions, the action of ultrasound, etc.);
- chemical (use of bactericidal and bacteriostatic agents);
- biological (antibacterial drugs, antitoxins, bacteriophages, proteolytic enzymes, etc.);
From the above, the general principles of asepsis follow:
- Anything that comes into contact with the wound (medical instruments) must be sterile.
- Classification of all diseased surgical departments into “clean” and “purulent”.
The role of the medical staff
The hands of health workers who are directly involved in the implementation of medical care, can be a factor in the transfer of pathogenic and conditionally pathogenic microorganisms. The microflora of the skin of the upper limbs can be of two types: permanent and transient. The first develops in the stratum corneum, sebaceous and sweat glands, hair follicles, and its representatives are epidermal staphylococcus, etc. The composition of permanent microflora is stable more or less and forms the protective function of the skin. In places of the periungual folds and on the interdigital surfaces, there may additionally be Staphylococcus aureus, pseudomonad, a different type of Escherichia coli, Klebsiella and other conditionally pathogenic microorganisms.
Transient microflora gets on the skin as a result of communication with contaminated areas of the patient's body or seeded with objects of the external environment. It remains on the surface of the skin for up to a day, is represented by pathogenic and conditionally pathogenic microbes, like a permanent microflora, it depends on the profile of the medical institution.
Different types of effects on the stratum corneum of the skin, which lead to an imbalance of permanent microflora (the use of brushes, detergent for hands with an alkaline environment, aggressive antiseptics, the absence of emollients in alcohol-containing antiseptics), contribute to the formation of dysbacteriosis of the skin. A characteristic indicator of it is the predominance of gram-negative conditionally pathogenic microflora in a permanent strain, including hospital strains that are resistant to antibacterial, antiseptic drugs and disinfectants. Thus, the hands of health workers can be both a factor in the transmission of the infectious principle and their source.
If the transient microflora can be removed mechanically (by hand washing and using antiseptic preparations), then the permanent population is practically not subject to destruction in this way.Sterilization of the skin is impossible and undesirable, because the preservation of the stratum corneum and a constant population of microorganisms prevents the colonization of more dangerous microbes.
Modern methods of processing the hands of the surgeon
In connection with the above physiology in the countries of Western Europe, the main methods of treating the hands of the surgeon (for Alfeld-Furbringer, Spasokukotsky-Kochergin) have undergone changes and improvements.
Of the large number of methods used at the present stage, only one of the skin disinfection of the skin of the hands is carried out according to the European standard, and is fixed in accordance with the procedure established by law as the “European Standard 1500” (EN 1500). Two-thirds of the countries of the European continent use this standard: Belgium, Ireland, Germany, the Netherlands, France, Greece, Iceland, Finland, Luxembourg, the Netherlands, Norway, Portugal, Austria, Italy, Sweden, Spain, Switzerland, the Czech Republic, and England.
It is recognized as the most suitable for the hygienic and surgical treatment of the hands of medical personnel. In the Russian Federation, instruction No. 113-0801 of September 5, 2001, which provides for methods of different types of treatment of the skin of the hands, forearms of operating surgeons.
Hygienic treatment of brushes
Indications for such treatment are as follows:
- communicating with patients with infectious diseases with a reliable or probable cause;
- contact with the physiological secretions of patients (pus, blood, feces, etc.);
- manual and instrumental explorations and actions;
- after visiting an infectious diseases hospital;
- after visiting the toilet room;
- at the end of the work shift.
Specific requirements for the processing of hands:
- antiseptic applied exclusively on dry skin;
- use elbow dispensers to avoid excess antiseptic;
- do not use additional items for the application of antiseptic;
- mandatory alternation of antiseptics, which contain active ingredients with different mechanisms of antibacterial action;
- the observance of the established sequence of actions, the dose of the agent and the exposure during the execution of each stage of treatment
The stages of hand hygiene
1. Antiseptic agent is applied on the skin in the amount of 3 ml and thoroughly rubbed for 30-60 seconds until completely dry. Next, you need to carry out the following manipulations:
- rub palmar planes against each other;
- rub the palm of the right hand on the back plane of the left hand and in the reverse order;
- rub the palmar surface, fingers crossed and splayed;
- rub the back surface of bent fingers on the palms of the other hand;
- rub the thumbs of the hands in circular steps;
- in circular steps, alternately rub the palmar surfaces with your fingertips and in the reverse order.
2. Contamination with biological materials is removed with a sterile cotton swab or cloth moistened with an antiseptic solution. Then apply 3 ml of an antiseptic to the surface of the brushes and rub into the skin until it is completely dry, paying particular attention to the interdigital, palmar and back surfaces for at least ½ minute, and rinse with running water followed by washing.
Surgical treatment of brushes and its stages
Surgical treatment of hands is a method of preparing limbs for carrying out surgical operations, dressings and other surgical procedures in order to disinfect the skin and prevent microbes from penetrating sterile objects and the wound surface.
Surgical treatment of the hands in the event of contact (direct or indirect) with sterile formations of the body (catheterization of blood vessels, puncture, etc.).
Stages of surgical treatment:
- Two-minute washing of hands and forearms without the use of additional funds with warm running water, soap with neutral pH.
- Drying with a sterile towel.
- 5-minute rubbing of the antiseptic into the skin surface of the hands and forearms in the standard way.
- Drying the skin in the air.
- Wearing sterile gloves.
- At the end of surgical procedures, remove gloves and rinse in warm water with liquid soap for two minutes. Then - lubrication with a nourishing cream.
Types of antiseptics
Types of asepsis depend on the method of using antiseptic drugs. Allocate local and general antiseptic. The first is subdivided into superficial (application of ointments, washing of wounds and cavities, etc.) and deep (administration of the drug to a wound or an inflammatory focus).
General aseptic is the saturation of the whole organism with an antiseptic preparation (antibacterial agent,sulfonamides), which subsequently gets into the infectious focus with blood or affects the microorganisms contained in the blood itself.
When applying this or that type of asepsis, it is necessary to remember its possible side effects: intoxication (using chemical antiseptics), damage to important anatomical structures (mechanical), photodermatitis (physical), allergy, dysbacteriological reactions, attachment of fungal lesions (biological), and so on.
Requirements for antiseptic agents
Preparations that are used for antiseptic treatment must meet the following requirements:
- wide spectrum of action;
- speed of action;
- complete disinfection (asepsis) of transient microorganisms;
- reducing the contamination of resident microflora to a normal level;
- long action after treatment (at least 3 hours);
- the absence of skin-irritating, allergenic, carcinogenic, mutagenic and other side effects;
- slow development of microflora resistance;
In conclusion, it can be said that the set of measures aimed at preventing the penetration of microorganisms into the wound is called "aseptic."This can be achieved by complete disinfection of all used objects in contact with the wound surface.
Aseptic and antiseptic - what is it? This question remains one of the topical issues in the medical field.